DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
101545 A. BUILDING __________
B. WING ______________ 		02/07/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION OF FLORIDA 4450 W EAU GALLIE BLVD STE 250, MELBOURNE, FL, 32934
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0559      
28608 Based on record review and staff interview, the agency failed to ensure the Condition of Participation for Quality Assessment & Performance Improvement requirement was met by failing to implement performance improvement project to track adverse incidents, analyze the causes and implement preventative action after a fall with significant injury (hip fracture) for 1 of 2 sampled patients (Patient #1). The cumulative effects of the agency's inability to implement performance improvement project for adverse incidents as required by the Condition of Participation for Quality Assessment/Performance Improvement. Cross reference L 560
L0587      
28608 Based on record review and staff interview, the agency failed to ensure the Condition of Participation for Core Services requirement was met by failing to ensure nursing services were provided and met the needs identified in the plan of care for 1 of 2 sampled patients (Patient #1). The agency failed to ensure the Registered Nurse performed adequate assessment and follow up after a fall with significant injury for 1 of 2 sampled patients (Patient #1). The agency failed to ensure the Registered Nurse conducted training and competency for hospice aides following a fall with significant injury when providing care for 1 of 2 sampled patients (Patient #1). The cumulative effect of these systemic problems resulted in the facility's inability to provide each patient with nursing care and services as required by the COP for Core Services. Cross reference L 591
L0591      
28608 Based on record review and staff interview, the agency failed to ensure nursing needs were identified, including an updated plan of care and assessment for 1 of 2 sampled patients (Patient #1). The findings include: Record review for Patient #1 revealed a 93-year-old female admitted to hospice services on 8/24/19. The diagnosis included: malignant neoplasm lung, metastases to brain, stomach and liver. The Plan of Care included Skilled Nurse (SN) 1 time week and Home Health Aide (HHA) 3 times a week. Review of the records revealed SN visits on 10/17, 10/25 and 10/30/19. The notes indicated there were no falls. Review of the record found Hospice Aide visits on 10/14; 10/16; 10/18; 10/23; 10/25; 10/28, and 10/30. On 11/1/19, Patient #1 refused a shower, stating she was feeling weak and dizzy. She documented that she told her son and called the Nurse when she left. Hospice Aide visits were made on 11/3/19 and 11/4/19. On 11/2/19, there was a SN Assessment, fall precautions in place and Continuous Care (CC) Aide was at bedside. There was no documentation of a change in condition as to why CC was put into place. On 11/3/19, the SN note revealed the reason for CC was status post-fall and increased confusion. There was no documentation as to when the fall occurred, if there was injury nor the circumstances. On 11/4/19, the SN documented CC ongoing related to post-fall with confusion and complaint of much pain. The SN documented at 17:30 pain medication was given, patient was in a lot of pain, and unable to rate pain level. Patient #1 remained in bed; she had a dressing to right side of her head, right elbow, outer knee and ecchymotic areas to legs and arms. Ice was placed on hip due to swelling. Review of Physician's note dated 11/4/19 revealed patient had been getter weaker and falling a lot. She fell while being walked to the bathroom by Continuous Care Aide. She bumped her head and injured her right hip. Upon examination, it appeared there was internal and external rotation pain. An x-ray was ordered suspecting hip fracture. Spoke with the son extensively about whether he wanted surgical repair, assuming the hip was fractured versus keeping her comfortable at home. He and family decided to keep her comfortable at home. Patient alert and said her right hip hurt. Periorbital ecchymois with swelling on right, tenderness and swelling over right hip; there was pain with external rotation. Review of the Physician's orders included: 11/1/19 CC put in place related to a fall. 11/4/19 x-ray of right hip, Norco 5/325 mg 2 tabs every 4 hours for pain, Morphine 0.25 ml and Ativan 0.5 mg 1 tab every 4 hours. Discontinue all routine medications. On 11/5/19, Patient #1's son called the agency and was upset that his mother had fallen when she had a Hospice Aide with her in the bathroom. He stated that on 11/4/19, his mother was in the bathroom with the Aide. He was in another room. The Aide came and requested his help to get her off the floor. The Continuous Care Supervisor visited on 11/5/19 and documented Patient #1 was unresponsive; had several bruises to forehead, lower extremities and bulge on right hip; x-ray verified fracture. The son reported to the Supervisor that the Hospice Aide was not paying attention and was listening to her phone via earphones. When the Supervisor questioned the Hospice Aide, she confirmed that she had not documented the fall in the notes because she filled out an Incident Report. Patient #1 died on 11/6/19. An interview was conducted with the Team Manager on 2/7/20 at 1:40pm. She was asked when Patient #1 fell. She said there was a fall on 11/1 and again on 11/4/19. She was asked for the documentation of the two falls. After review, she said she could not locate the notes of the 2 falls. When asked how she was informed of the falls, she said from the RN Case Manager. She was asked if there was staff present at the time of the falls. She said there was a Hospice Aide on 11/4/19 at the time of the fall; however, she did not report the incident or document in the notes what occurred. She was asked if there were any injuries reported or documented at the time of the first fall on 11/1/19. She said not that she was aware. When asked what the protocol was after a fall, she said staff were to report any fall or incident at the time it occurred, and document the incident in the clinical record. Also, all patients must be seen by the RN Case Manager the same day if there are reports of injury. She was asked who assessed Patient #1 after the falls. She said the RN Case Manager (Emp B). She was asked who was responsible to investigate how the falls occurred, and she replied the Case Manager. When asked to review the investigations, she said there were none. An interview was conducted on 2/7/20 at 2:27pm with the Patient Care Administrator (PCA). She was asked for the documentation regarding the falls on 11/1 and 11/4 for Patient #1. She said the Team Manager was reviewing the records to find the documentation. After review of the records, she said the documentation for the falls could not be found. She said CC care was initiated on 11/1/19 relating to a fall; however, the date of the fall could not be determined. When asked for the circumstances of the fall on 11/4, she said the Hospice Aide on duty with Patient #1 did not document the fall in the record.
L0607      
28608 Based on record review and staff interview, the agency failed to ensure the Condition of Participation for Hospice Aide and Homemaker Services requirement was met by failing to ensure hospice aides provided care and services as identified in the plan of care for 1 of 2 sampled patients (Patient #1). The agency failed to ensure hospice aides were adequately trained to report all falls/incidents immediately after the occurrence and document in the clinical record for 1 of 2 sampled patients (Patient #1). The cumulative effect of these systemic problems resulted in the facility's inability to provide each patient with appropriate safety measures as required by the COP for Hospice Aides. Cross reference L 608
L0628      
28608 Based on record review and staff interview, the agency failed to ensure the Hospice Aides reported alll changes in patient's condition including falls/incidents for 1 of 2 sampled patients (Patient #1). The findings include: Record review for Patient #1 revealed she had a fall at home on 11/4/19 in the bathrooom, with Hospice Aide (HA) (Emp A) in attendance. Her son was home at the time and was summoned by the Hospice Aide (HA) to assist his mother from the floor. The HA did not document the fall in the clinical record and failed to immediately contact the agency. The agency was not aware until the next shift, when the ongoing employee was informed. The employee coming on duty was a Licensed Practical Nurse. She evaluated Patient #1 and immediately notified the agency and physician. An interview was conducted with the Team Manager on 2/7/20 at 1:40pm. She was asked when Patient #1 fell. She said there was a fall on 11/1 and again on 11/4/19. She was asked for the documentation of the two falls. After review, she said she could not locate the notes of the 2 falls. When asked how she was informed of the falls, she said from the RN Case Manager. She was asked if there was staff present at the time of the falls. She said there was a Hospice Aide on 11/4/19 at the time of the fall; however, she did not report the incident nor document in the notes what occurred. She was asked if there were any injuries reported or documented at the time of the first fall on 11/1/19. She said not that she was aware. When asked what the protocol was after a fall, she said staff were to report any fall or incident at the time it occurred, and document the incident in the clinical record. Review of the agency policy revealed Incident Reporting and Resolution: Reporting the incident to their Supervisor within one hour of their knowledge of the occurrence. Completing all applicable Incident Report forms within 24-hours of their knowledge of the incident.
L0648      
28608 Based on record review and staff interview, the agency Administrator failed to ensure the Condition of Participation for Organization Environment requirement was met by failing to implement policies and procedures for reporting falls/ incidents and documenting in the clinical record for 1 of 2 sampled patients (Patient #1). The agency failed to have a system in place to audit clinical records and investigate all falls. The agency failed to ensure hospice aides competency were re-evaluated and education provided after a fall with significant injuries. The agency failed to implement performance improvement project to address auditing of clinical records and reporting of adverse incidents. The cumulative effect of these systemic problems resulted in the agency's inability to organize, manage, and administer its resources to patients to attain and maintain their highest practicable functional capacity as required by the Condition of Participation for Organization Environment. Cross reference L 651
L0651      
28608 Based on record review and staff interview the agency Administrator failed to ensure the home health agency implemented policies and procedures for reporting falls/ incidents and documenting in the clinical record for 1 of 2 sampled patients (Patient #1). The findings include: Record review for Patient #1 revealed a 93-year-old female admitted to hospice services on 8/24/19. The diagnosis included: malignant neoplasm lung, metastases to brain, stomach and liver. The Plan of Care included Skilled Nurse (SN) 1 time week and Home Health Aide (HHA) 3 times a week. Review of the records revealed SN visits on 10/17, 10/25 and 10/30/19. The notes indicated there were no falls. Review of the record found Hospice Aide visits on 10/14; 10/16; 10/18; 10/23; 10/25; 10/28, and 10/30. On 11/1/19, Patient #1 refused a shower, stating she was feeling weak and dizzy. She documented that she told her son and called the Nurse when she left. Hospice Aide visits were made on 11/3/19 and 11/4/19. On 11/2/19, there was a SN Assessment, fall precautions in place and Continuous Care (CC) Aide was at bedside. There was no documentation of a change in condition as to why CC was put into place. On 11/3/19, the SN note revealed the reason for CC was status post-fall and increased confusion. There was no documentation as to when the fall occurred, if there was injury nor the circumstances. On 11/4/19, the SN documented CC ongoing related to post-fall with confusion and complaint of much of pain. The SN documented at 17:30 pain medication was given, patient was in a lot pain, and unable to rate pain level. Patient #1 remained in bed; she had a dressing to right side of her head, right elbow, outer knee and ecchymotic areas to legs and arms. Ice was placed on hip due to swelling. Review of Physician's note dated 11/4/19 revealed patient had been getter weaker and falling a lot. She fell while being walked to bathroom by Continuous Care Aide. She bumped her head and injured her right hip. Upon examination, it appeared there was internal and external rotation pain. An x-ray was ordered suspecting hip fracture. Spoke with the son extensively about whether he wanted surgical repair, assuming the hip was fractured versus keeping her comfortable at home. He and family decided to keep her comfortable at home. Patient alert and said her right hip hurt. Periorbital ecchymois with swelling on right, tenderness and swelling over right hip; there was pain with external rotation. Review of the Physician's orders included: 11/1/19 CC put in place related to a fall. 11/4/19 x-ray of right hip, Norco 5/325 mg 2 tabs every 4 hours for pain, Morphine 0.25 ml and Ativan 0.5 mg 1 tab every 4 hours. Discontinue all routine medications. On 11/5/19, Patient #1's son called the agency and was upset that his mother had fallen when she had a Hospice Aide with her in the bathroom. He stated that on 11/4/19, his mother was in the bathroom with the Aide. He was in another room. The Aide came and requested his help to get her off the floor. The Continuous Care Supervisor visited on 11/5/19 and documented Patient #1 was unresponsive; had several bruises to forehead, lower extremities and bulge on right hip; x-ray verified fracture. The son reported to the Supervisor that the Hospice Aide was not paying attention and was listening to her phone via earphones. When the Supervisor questioned the Hospice Aide, she confirmed that she had not documented the fall in the notes because she filled out an Incident Report. Patient #1 died on 11/6/19. An interview was conducted on 2/7/20 at 2:27pm with Patient Care Administrator (PCA). She was asked for the documentation regarding the falls on 11/1 and 11/4 for Patient #1. She said the Team Manager was reviewing the records to find the documentation. After review of the records she said the documentation for the falls could not be found. She said CC care was initiated on 11/1/19 relating to a fall; however, the date of the fall could not be determined. When asked for the circumstances of the fall on 11/4, she said the Hospice Aide on duty with Patient #1 did not document the fall in the record. An interview was conducted with the Senior General Manager on 2/7/20 at 3:45pm. When asked if she was aware that Patient #1 had falls on 11/1 and 11/4/19, she said she had been made aware. When asked why there was no documentation in the record regarding the falls, she said, there should always be documentation of any fall or incidents. She was asked if the falls had been investigated. She said the Case Manager visited Patient #1 after the falls. There were no investigations found. Who was responsible for auditing the clinical record after a fall and ensure appropriate follow-up? The Case Manager and Team Managers? She was asked if she was aware that Employee A had not reported the fall on 11/4/19 which resulted in a fractured hip. She was made aware when the son called and reported the incident. The Physician was immediately notified and made a visit to the home. An x-ray was ordered as well as pain medication. Review of the agency policy Incident Reporting and Resolution included: Reporting the incident to their Supervisor within one hour of their knowledge of the occurrence. Completing all applicable Incident Report forms within 24-hours of their knowledge of the incident. The Program Senior Management is responsible for: reporting incidents or unusual occurrences to all local, state and federal agencies as mandated by applicable regulations.